Healthcare Provider Details

I. General information

NPI: 1417698390
Provider Name (Legal Business Name): BRADY LYNN BURNS MD, MBS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2022
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1522 E A ST
CASPER WY
82601-2217
US

IV. Provider business mailing address

1522 E A ST
CASPER WY
82601-2217
US

V. Phone/Fax

Practice location:
  • Phone: 307-234-6161
  • Fax:
Mailing address:
  • Phone: 307-234-6161
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: